Objectives. Provide a framework for comprehensive pain evaluation and individualized multimodal treatment. Improve quality of life and function in patients experiencing pain, while reducing the morbidity and mortality associated with pain treatments, particularly opioid analgesics.
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In addition to a usual history and physical examination, in patients with chronic pain assess the following (Table 3):
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Pain intensity. A patient’s report of pain intensity provides a subjective gauge of the distraction and interference pain causes in their daily life.
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Social, personal, and family risks. Being an opioid user carries a risk for social stigma. Additional risks are inherent to possessing opioids, including becoming a target for home invasion. Insecure storage may put other family members and pets at risk for opioid poisoning.
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Approximate percentage: establish the percentage of pain each pain generator is contributing to the overall clinical status.
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Treatment. In the treatment plan, address both the underlying cause and the associated acute pain. In developing a treatment plan for the acute pain, consider the degree of tissue trauma, the patient’s situation, and any unique patient factors.